胰十二指肠肿瘤隔离冷冻治疗的可行性研究

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冷冻对恶性肿瘤有确切治疗效果,但常规胰十二指肠区域冷冻后常发生邻近的消化道损伤等严重并发症,从而限制了冷冻治疗在该区域肿瘤治疗中的临床应用。为此,作者设计了在重建消化道的基础上,胰腺十二指肠肿瘤隔离冷冻的方法,并通过动物实验验证其可行性。实验采用健康家猪4只,开腹后分别作胆总管、胰体尾、胃肠、肠肠离断,除后方的门静脉和肠系膜血管外,将胰十二指肠区和其它腹内器官隔离,用LCS2000外科冷冻治疗机,以-170℃低温,持续10分钟的技术条件,将此区重复冷冻2次,而后作胃肠和胆肠吻合。结果:术后动物全部存活,胰淀粉酶在短暂增高后迅速恢复正常,肝功能和血糖无明显变化。除1例发生较小的胰腺假性囊肿外,无任何胆、胰、肠的并发症。作者强调一定深度和作用时间的超低温是破坏胰腺组织和预防冷冻后胰腺炎的主要措施。文中还对相关的技术因素进行了讨论,认为胰十二指肠区隔离冷冻将为不能手术切除的晚期胰十二指肠肿瘤提供一种可供选择的治疗方法 Freezing has a definite therapeutic effect on malignant tumors, but serious complications such as adjacent gastrointestinal lesions often occur after routine freezing in the pancreatic duodenum, which limits the clinical application of cryotherapy in the treatment of cancer in this area. To this end, the authors designed a method for isolating frozen pancreas and duodenum on the basis of reconstruction of the digestive tract, and verified its feasibility through animal experiments. Four healthy domestic pigs were used in the experiment. After the laparotomy, the common bile duct, pancreatic body tail, gastrointestinal tract, and intestine were severed. The pancreatic and duodenal regions and other intra-abdominal organs were isolated except for the posterior portal vein and mesenteric vessels. Using the LCS2000 surgical cryotherapy machine, with a temperature of -170°C for 10 minutes, this zone was repeatedly frozen 2 times and then subjected to gastrointestinal and biliary-enteric anastomosis. RESULTS: After all the animals survived, pancreatic amylase quickly returned to normal after a brief increase, and there was no significant change in liver function and blood glucose. Except for one case of small pancreatic pseudocysts, there were no complications of gallbladder, pancreas, or intestine. The authors emphasize that hypothermia with a certain depth and duration of action is the main measure to destroy pancreatic tissue and prevent pancreatitis after freezing. The relevant technical factors were also discussed in the article. It is believed that isolation of the pancreaticoduodenal region will provide an alternative treatment method for advanced pancreatoduodenal tumors that cannot be surgically resected.
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